EFFECTIVENESS OF HEALTH EDUCATION ON INFANT AND YOUNG CHILD FEEDING BEHAVIOR TO PREVENT STUNTING IN CHILDREN UNDER 2 YEARS: A SYSTEMATIC REVIEW
DOI:
https://doi.org/10.37268/mjphm/vol.26/no.1/art.3308Keywords:
Health education, child nutrition, stunting, breastfeeding, growth and development.Abstract
Stunting in children under two years remains a critical global health challenge. While health education is a primary strategy, its effectiveness in reducing stunting—as opposed to merely changing behavior—remains debated. This systematic review aimed to evaluate the effectiveness of health education on Infant and Young Child Feeding (IYCF) behaviors and stunting prevention. Following PRISMA 2020 guidelines, a search was conducted in PubMed, Scopus, and ScienceDirect for studies published between 2014 and 2024. Inclusion criteria encompassed Randomized Controlled Trials (RCTs) and non-randomized studies evaluating maternal education. Risk of bias was assessed using Cochrane RoB 2 and JBI tools. Data synthesis was conducted using a narrative approach based on the Synthesis Without Meta-analysis (SWiM) framework. Nine studies met the inclusion criteria (six RCTs, three non-randomized). Narrative synthesis indicated that health education consistently improved Early Initiation of Breastfeeding, Exclusive Breastfeeding, and Dietary Diversity. Interventions combining interpersonal counseling with mass media or utilizing peer counselors demonstrated stronger behavioral impacts. However, the impact on linear growth (HAZ/stunting) was inconsistent. Improvements in nutritional status were more evident when education was integrated with health system strengthening or nutritional supplementation, rather than as a standalone intervention in food-insecure populations. Health education is effective in improving feeding behaviors but has variable capacity to reduce stunting if implemented alone. Behavioral improvements do not necessarily translate into child growth when structural barriers persist. Future policies should integrate education with nutrition-sensitive interventions, such as food security and sanitation, to achieve measurable impacts on child growth.
References
Abdulahi, M., Fretheim, A., Argaw, A., & Magnus, J. H. (2021). Breastfeeding education and support to improve early initiation and exclusive breastfeeding practices and infant growth: A cluster randomized controlled trial from a rural ethiopian setting. Nutrients, 13(4). https://doi.org/10.3390/nu13041204
Abebe, Z., Haki, G. D., & Baye, K. (2016). Health Extension Workers’ Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated with Mothers’ Knowledge and Child Stunting in Rural Ethiopia. Food and Nutrition Bulletin, 37(3). https://doi.org/10.1177/0379572116651209
Abiyu, C., & Belachew, T. (2020). Effect of complementary feeding behavior change communication delivered through community-level actors on dietary adequacy of infants in rural communities of West Gojjam Zone, Northwest Ethiopia: A cluster-randomized controlled trial. PLoS ONE, 15(9 September). https://doi.org/10.1371/journal.pone.0238355
Admasu, J., Egata, G., Bassore, D. G., & Feleke, F. W. (2022). Effect of maternal nutrition education on early initiation and exclusive breast-feeding practices in south Ethiopia: a cluster randomised control trial. Journal of Nutritional Science, 11. https://doi.org/10.1017/jns.2022.36
Ara, G., Khanam, M., Papri, N., Nahar, B., Haque, M. A., Kabir, I., & Dibley, M. J. (2018). Peer counselling improves breastfeeding practices: A cluster randomized controlled trial in urban Bangladesh. Maternal and Child Nutrition, 14(3). https://doi.org/10.1111/mcn.12605
Bhandari, N., Mazumder, S., Bahl, R., Martines, J., Black, R. E., & Bhan, M. K. (2004). An educational intervention to promote appropriate complementary feeding practices and physical growth in infants and young children in Rural Haryana, India. Journal of Nutrition, 134(9). https://doi.org/10.1093/jn/134.9.2342
Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., Mathers, C., & Rivera, J. (2008). Maternal and child undernutrition: global and regional exposures and health consequences. In The Lancet (Vol. 371, Issue 9608). https://doi.org/10.1016/S0140-6736(07)61690-0
Ekaningrum, A. Y., & Sulistiyorini, D. (2022). Systematic Review: Relationship between Infant and Young Child Feeding Practices with Stunting in Indonesia. https://doi.org/10.5220/0010756500003235
Elni, E., & Julianti, E. (2020). The Correlation between Feeding Habit Factor and The Incidence of Stunting in Children Under Five Years. Jurnal Keperawatan Padjadjaran, 8(3). https://doi.org/10.24198/jkp.v8i3.1554
EPHI and ICF. (2019). Ethiopia Mini Demographic and Health Survey 2019: key Indicators. In Rockville, Maryland, USA: EPHI and ICF (Issue Key findings).
Gopalakrishnan, S., & Ganeshkumar, P. (2013). Systematic reviews and meta-analysis: Understanding the best evidence in primary healthcare. Journal of Family Medicine and Primary Care, 2(1). https://doi.org/10.4103/2249-4863.109934
Haque, N. B., Mihrshahi, S., & Haider, R. (2023). Peer counselling as an approach to improve complementary feeding practices: a narrative review. In Journal of Health, Population and Nutrition (Vol. 42, Issue 1). https://doi.org/10.1186/s41043-023-00408-z
Higgins, J. P. T., Thompson, S. G., Deeks, J. J., & Altman, D. G. (2003). Measuring inconsistency in meta-analyses. In British Medical Journal (Vol. 327, Issue 7414). https://doi.org/10.1136/bmj.327.7414.557
Hutton, B., Catalá-López, F., & Moher, D. (2016). The PRISMA statement extension for systematic reviews incorporating network meta-analysis: PRISMA-NMA. Medicina Clínica (English Edition), 147(6). https://doi.org/10.1016/j.medcle.2016.10.003
Ickes, S. B., Baguma, C., Brahe, C. A., Myhre, J. A., Adair, L. S., Bentley, M. E., & Ammerman, A. S. (2017). Maternal participation in a nutrition education program in Uganda is associated with improved infant and young child feeding practices and feeding knowledge: A post-program comparison study. BMC Nutrition, 3(1). https://doi.org/10.1186/s40795-017-0140-8
Kang, Y., Suh, Y. K., Debele, L., Juon, H. S., & Christian, P. (2017). Effects of a community-based nutrition promotion programme on child feeding and hygiene practices among caregivers in rural Eastern Ethiopia. Public Health Nutrition, 20(8). https://doi.org/10.1017/S1368980016003347
Kim, S. S., Nguyen, P. H., Tran, L. M., Sanghvi, T., Mahmud, Z., Haque, M. R., Afsana, K., Frongillo, E. A., Ruel, M. T., & Menon, P. (2018). Large-Scale Social and Behavior Change Communication Interventions Have Sustained Impacts on Infant and Young Child Feeding Knowledge and Practices: Results of a 2-Year Follow-Up Study in Bangladesh. Journal of Nutrition, 148(10). https://doi.org/10.1093/jn/nxy147
Kim, S. S., Rawat, R., Mwangi, E. M., Tesfaye, R., Abebe, Y., Baker, J., Frongillo, E. A., Ruel, M. T., & Menon, P. (2016). Exposure to large-scale social and behavior change communication interventions is associated with improvements in infant and young child feeding practices in Ethiopia. PLoS ONE, 11(10). https://doi.org/10.1371/journal.pone.0164800
Kurniati, E., Suwono, H., Ibrohim, I., Suryadi, A., & Saefi, M. (2022). International Scientific Collaboration and Research Topics on STEM Education: A Systematic Review. Eurasia Journal of Mathematics, Science and Technology Education, 18(4). https://doi.org/10.29333/ejmste/11903
Liang, W., Xing, Y., Pang, M., Wang, D., & Yan, H. (2018). Community health education improves child health care in Rural Western China. BMC Pediatrics, 18(1). https://doi.org/10.1186/s12887-018-1084-0
Mahumud, R. A., Uprety, S., Wali, N., Renzaho, A. M. N., & Chitekwe, S. (2022). The effectiveness of interventions on nutrition social behaviour change communication in improving child nutritional status within the first 1000 days: Evidence from a systematic review and meta-analysis. In Maternal and Child Nutrition (Vol. 18, Issue 1). https://doi.org/10.1111/mcn.13286
Methley, A. M., Campbell, S., Chew-Graham, C., McNally, R., & Cheraghi-Sohi, S. (2014). PICO, PICOS and SPIDER: A comparison study of specificity and sensitivity in three search tools for qualitative systematic reviews. In BMC Health Services Research (Vol. 14, Issue 1). https://doi.org/10.1186/s12913-014-0579-0
Mistry, S. K., Hossain, M. B., & Arora, A. (2019). Maternal nutrition counselling is associated with reduced stunting prevalence and improved feeding practices in early childhood: A post-program comparison study. Nutrition Journal, 18(1). https://doi.org/10.1186/s12937-019-0473-z
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology, 62(10). https://doi.org/10.1016/j.jclinepi.2009.06.005
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., Estarli, M., Barrera, E. S. A., Martínez-Rodríguez, R., Baladia, E., Agüero, S. D., Camacho, S., Buhring, K., Herrero-López, A., Gil-González, D. M., Altman, D. G., Booth, A., … Whitlock, E. (2016). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Revista Espanola de Nutricion Humana y Dietetica, 20(2). https://doi.org/10.1186/2046-4053-4-1
Nikièma, L., Huybregts, L., Martin-Prevel, Y., Donnen, P., Lanou, H., Grosemans, J., Offoh, P., Dramaix-Wilmet, M., Sondo, B., Roberfroid, D., & Kolsteren, P. (2017). Effectiveness of facility-based personalized maternal nutrition counseling in improving child growth and morbidity up to 18 months: A cluster-randomized controlled trial in rural Burkina Faso. PLoS ONE, 12(5). https://doi.org/10.1371/journal.pone.0177839
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., & Moher, D. (2021). Updating guidance for reporting systematic reviews: development of the PRISMA 2020 statement. Journal of Clinical Epidemiology, 134. https://doi.org/10.1016/j.jclinepi.2021.02.003
Phu, hine-W.-W., Wittayasooporn, J., & Kongsaktrakul, C. (2019). Influence of child feeding practices and selected basic conditioning factors on stunting in children between 6 and 24 months of age in Myanmar. Makara Journal of Health Research, 23(2). https://doi.org/10.7454/msk.v23i2.10397
Rakotomanana, H., Gates, G. E., Hildebrand, D., & Stoecker, B. J. (2017). Situation and determinants of the infant and young child feeding (IYCF) indicators in Madagascar: Analysis of the 2009 Demographic and Health Survey. In BMC Public Health (Vol. 17, Issue 1). https://doi.org/10.1186/s12889-017-4835-1
Sarkar, P., Rifat, M. A., Bakshi, P., Talukdar, I. H., Pechtl, S. M. L., Lindström Battle, T., & Saha, S. (2023). How is parental education associated with infant and young child feeding in Bangladesh? a systematic literature review. BMC Public Health, 23(1). https://doi.org/10.1186/s12889-023-15173-1
Scott, M., Malde, B., King, C., Phiri, T., Chapota, H., Kainja, E., Banda, F., & Vera-Hernandez, M. (2018). Family networks and infant health promotion: A mixed-methods evaluation from a cluster randomised controlled trial in rural Malawi. BMJ Open, 8(6). https://doi.org/10.1136/bmjopen-2017-019380
Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., Stewart, L. A., Altman, D. G., Booth, A., Chan, A. W., Chang, S., Clifford, T., Dickersin, K., Egger, M., Gøtzsche, P. C., Grimshaw, J. M., Groves, T., Helfand, M., … Whitlock, E. (2015). Preferred reporting items for systematic review and meta-analysis protocols (prisma-p) 2015: Elaboration and explanation. In BMJ (Online) (Vol. 349). https://doi.org/10.1136/bmj.g7647
Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, 104. https://doi.org/10.1016/j.jbusres.2019.07.039
Stewart, L. A., Clarke, M., Rovers, M., Riley, R. D., Simmonds, M., Stewart, G., & Tierney, J. F. (2015). Preferred reporting items for a systematic review and meta-analysis of individual participant data: The PRISMA-IPD statement. In JAMA - Journal of the American Medical Association (Vol. 313, Issue 16). https://doi.org/10.1001/jama.2015.3656
Tamiru, D., & Tamrat, M. (2015). Constraints to the optimal breastfeeding practices of breastfeeding mothers in the rural communities of Arba Minch Zuria Woreda, Ethiopia: A community-based, cross-sectional study. South African Journal of Clinical Nutrition, 28(3). https://doi.org/10.1080/16070658.2015.11734548
Tariku, B., Whiting, S. J., Mulualem, D., & Singh, P. (2015). Application of the Health Belief Model to Teach Complementary Feeding Messages in Ethiopia. Ecology of Food and Nutrition, 54(5). https://doi.org/10.1080/03670244.2015.1049344
Vazir, S., Engle, P., Balakrishna, N., Griffiths, P. L., Johnson, S. L., Creed-Kanashiro, H., Fernandez Rao, S., Shroff, M. R., & Bentley, M. E. (2013). Cluster-randomized trial on complementary and responsive feeding education to caregivers found improved dietary intake, growth and development among rural Indian toddlers. Maternal and Child Nutrition, 9(1). https://doi.org/10.1111/j.1740-8709.2012.00413.x
Victora, C. G., De Onis, M., Hallal, P. C., Blössner, M., & Shrimpton, R. (2010). Worldwide timing of growth faltering: Revisiting implications for interventions. Pediatrics, 125(3). https://doi.org/10.1542/peds.2009-1519
Woldemichael, B. (2016). Timely Initiation of Breastfeeding and Its Associated Factors among Mothers in Tiyo Woreda, Arsi Zone, Ethiopia: A Community- Based Cross Sectional Study. Clinics in Mother and Child Health, 13(01). https://doi.org/10.4172/2090-7214.1000221
Xiao, Y., & Watson, M. (2019). Guidance on Conducting a Systematic Literature Review. In Journal of Planning Education and Research (Vol. 39, Issue 1). https://doi.org/10.1177/0739456X17723971